Provider Demographics
NPI:1083809768
Name:MATEO MEDICAL GROUP
Entity Type:Organization
Organization Name:MATEO MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUBICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-685-9940
Mailing Address - Street 1:2905 S EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-2730
Mailing Address - Country:US
Mailing Address - Phone:650-570-2273
Mailing Address - Fax:650-570-4266
Practice Address - Street 1:2905 S EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-2730
Practice Address - Country:US
Practice Address - Phone:650-570-2273
Practice Address - Fax:650-570-4266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty